The doctor is out

One of the area's few house call doctors faces dogs, traffic and the high cost of gas, but he's a lot happier now

Beth Francis

12:05 AM, Jul 15, 2006

Dr. Andy Oakes-Lottridge has no nurses, no waiting room, no office at all where patients can visit.

Patients have his cell phone number and can call anytime. He keeps track of patient records in an office at his Fort Myers home.

Some might say he's taking the delivery of medicine back in time, but the truth is he's part of a trend in which doctors are making more house calls, especially in areas of the country where there is a large elderly population and patients who have a tough time getting to a doctor's office, says Constance Row, executive director of the American Academy of Home Care Physicians.

"A lot of people think of house calls as something from a past era in medicine, but the practice is becoming increasingly more popular," Row says. "This is in part because of Medicare's decision in 1998 to boost what it pays for home visits to patients, so it's not as much of a money-losing proposition for doctors."

An analysis in the May issue of the Journal of the American Medical Association found that house calls to Medicare beneficiaries rose by 40 percent between 1998 and 2004.

Although he's following in the footsteps of his father and great-grandfather, Oakes-Lottridge is cutting-edge, she says, because he is one of a growing number of doctors hanging out their shingles as house-call-only physicians. He is the only physician or group in Southwest Florida listed in the association's referral base, and one of only 16 in Florida.

He schedules about three patients a day, alloting an hour for each, driving his Honda Accord between Lee and Collier counties. He also makes time to see patients who call in with emergencies.

The doctor wanted more time to spend with patients, and wanted more time with his wife and three children.

He says he just wasn't happy working at a large group practice in Cape Coral, where he had only about 10 minutes to spend with each patient, and was swamped with 12- to 14-hour days.

"Unfortunately, our system of medical care rewards volume, and has given birth to a system of coding and billing that has reduced compensation dramatically," he says.

"Doctors are forced to make up for the reduction by increasing their volume of patients. Patients aren't happy because they face long waits and their busy doctor is difficult to reach by phone to answer simple questions, and I was unhappy because my ability to get to know my patients and provide the level of personalized care that I would want if the tables were reversed was significantly damaged."

He launched his house-call practice, officially called Personalized Health Care, a year ago, with the slogan: "Health care the way it used to be. The way it should be, and the way it is with us."

He says he considers it a privilege when patients allow him into the intimacy of their homes. It implies a significant level of trust.

"Seeing them in their own homes allows me to see them in their surroundings and get to know them better," he says. "It does a lot to enhance the level of rapport."

He still works long days — about 10 hours a day or so — but he has the flexibility to be free to attend open houses at his childrens' school, or be there for his daughter's violin performances. He knows he can work at his computer at night after the kids are in bed.

"I'm also influenced by my father, who I watched make house calls when I was a kid growing up in New York," he says. "There's just a certain feel about it."

Days of old

Dr. Bob Oakes of Brooklyn, N.Y., says he's proud to see his son — the second of five children, and the only doctor — following in his footsteps.

Oakes, 65, says being a house-call physician has become a family tradition. He remembers when his own grandfather, a Chicago physician who only made house calls, had such compassion for the financial considerations of his patients that he often accepted goods for his services instead of money.

"One patient gave him a diamond ring," Oakes says. "In that day, people went into medicine because they wanted to take care of people. Doctors today feel the same about going into the profession, but many are disappointed when they face the realities of actually practicing medicine. Being a doctor today just isn't as fun anymore."

House calls were the norm for doctors until the end of the 19th century, when the rise of hospitals and health insurance, along with improved transportation, led to a shift toward office-based practices. By the 1970s, fewer than 5 percent of doctors were making house calls. The advent of managed care in the mid '70s made house calls even more difficult because there was no reimbursement, he says.

Oakes, who has practiced for 35 years, says house calls are the best way to be the best possible doctor.

"In someone's home, you're party to a vast array of information you'd never get in the office," he says. "You see how someone lives, you meet their family, you get a better feel for who's going to take care of mom and how competent they may be."

Primary care isn't that high-tech and can be easily delivered in the home, he says.

"You're providing care on a basic level and you know when to refer," he says. "In the home you are more a part of patients' lives. Being there when someone dies is an awesome experience. You are able to offer care and compassion full-circle. Families come to these experiences unprepared, and you are able to be there."

House calls of today

The 36-year-old Oakes-Lottridge, with a head of thick brown hair and smartly dressed in a suit and tie, defies the old television image of Marcus Welby.

His high-tech black bag is stocked so he can deliver a full range of care: A portable EKG machine, a nebulizer machine for breathing disorders, blood glucose and oxygen saturation monitors, and tests for checking for urine infections, strep throat and flu infections.

He also has equipment to perform minor skin biopsies and stitch up wounds. There's also a storage container for disposing contaminated supplies.

Oakes-Lottridge (who took on the maiden name of his wife, Denise, when they married) says it's tougher to make a living making house calls, especially now while he's trying to build the practice. He says he has between 30 and 40 patients, though he has fewer to see during the summer months because some are winter residents.

He charges an annual fee of $2,500 to $4,500, depending on age and other factors. Patients can pay in full or quarterly. This includes regular visits, as well as urgent-care calls. He also sees people in hotels and out-of-town guests of patients, charging $250-$300 for those urgent calls.

On the downside: traffic and the high cost of gas. But he likes the fact he doesn't have to deal with insurance paperwork headaches, which means he doesn't need to pay a staff.

Some PPO plans will reimburse patients for a percentage of his bill, but only if he's out of network. He'll assist patients with paperwork, but it's ultimately their responsibility. And while Medicare does pay for house calls, the government program will only do so if a patient is homebound, he says.

He sees the profession returning to a pay-for-service arrangement at some point.

"But being out of network for (insurance companies) has greatly simplified my practice; I give my patients a bill and they pay me," he says.

What patients say

East Fort Myers resident Mary Anne Baker, 72, says it used to be a battle to get her husband, Jim, 63, to the doctor.

"He's got multiple sclerosis and he can barely move," she says. "I couldn't get him in and out of the car anymore. His legs don't work."

"Knowing I can call Dr. AOL anytime has lifted a burden off my shoulders," she says, explaining that she calls him that because those are his initials — and part of his e-mail address. "I'm confident I can call him at any time. Jim had fungus in a toenail really bad and he came out here and removed the nail.

"He gives me peace of mind."

Mariana Kaegebein of Bonita Springs says she was seeing multiple doctors for multiple medical problems before becoming a patient.

"I was tired of waiting in waiting rooms and I didn't feel like my doctors were getting to know me," she says. "When I heard about Dr. Oakes-Lottridge, the thing that appealed to me was that it was very personal care. He's a doctor who really wants to get to know you and take care of you. He has streamlined my care. He provides a continuity I didn't have before."

Kaegebein, 65, says she pays $4,500 a year, but it's worth it because it's much less than the more than the $30,000 she spent on medical care last year — including health insurance co-pays, premiums, neurological testing and other therapies not covered by insurance.

And the personal attention is priceless, she says.

"He was out of town when I got sick last week and was having trouble sleeping, so I e-mailed him and he e-mailed me back the next day. He contacted a pharmacy here and ordered a prescription for me from out of the country," she says. "Now, that's service."

Gregory Casey of Bonita Springs is also a big fan.

"It saves me a lot of time and aggravation, not to mention the excellent care," says the 35-year-old oral surgeon. "The doctor-patient relationship is easier to form, and Andy has the sort of personality to carry this thing off; not any doctor could do it," he says.

"Some doctors like to have the upper hand in their own domain, on their own turf, but Andy isn't like that. He's modest. He's not on that power trip.